软通道微创穿刺引流术对老年高血压脑出血患者脑水肿及血清皮质醇、促肾上腺皮质激素水平的影响研究

Effect of Soft Channel Minimally Invasive Puncture and Drainage on Brain Edema and Serum Cortisol and Adrenocorticotropic Hormone Levels in Elderly Patients with Hypertensive Intracerebral Hemorrhage

背景高血压脑出血病情发展迅速,50%患者出现剧烈头痛,约10%患者出现痫性发作,起病后随时会威胁患者的生命安全。目的探讨软通道微创穿刺引流术对老年高血压脑出血患者脑水肿及血清皮质醇(Cor)、促肾上腺皮质激素(ACTH)水平的影响。方法选取2018年5月至2020年5月武穴市第一人民医院收治的老年高血压脑出血患者62例为研究对象。根据手术方式将患者分为观察组(n=32)和对照组(n=30)。对照组采取传统开颅术治疗,观察组采取软通道微创穿刺引流术治疗。比较两组患者一般资料、手术相关指标(包括手术时间、血肿清除时间、脑脊液恢复正常时间)、不同时间(术前、术后1周和术后2周)周围脑水肿体积和不同时间(术前、术后3 d和术后7 d)血清Cor、ACTH水平及术后并发症发生率。结果观察组患者手术时间、血肿清除时间、脑脊液恢复正常时间短于对照组(P<0.05)。手术方式与时间在周围脑水肿体积上存在交互作用(P<0.05);手术方式、时间在周围脑水肿体积上主效应显著(P<0.05)。观察组患者术后1周、术后2周周围脑水肿体积小于对照组(P<0.05)。对照组、观察组患者术后1周、术后2周周围脑水肿体积分别大于本组术前,术后2周周围脑水肿体积分别小于本组术后1周(P<0.05)。手术方式与时间在血清Cor、ACTH水平上存在交互作用(P<0.05);手术方式、时间在血清Cor、ACTH水平上主效应显著(P<0.05)。观察组患者术后3 d、术后7 d血清Cor、ACTH水平低于对照组(P<0.05)。对照组、观察组患者术后3 d血清Cor、ACTH水平分别高于本组术前,术后7 d血清Cor、ACTH水平分别低于本组术前、术后3 d(P<0.05)。观察组患者术后并发症发生率低于对照组(P<0.05)。结论对老年高血压脑出血患者采取软通道微创穿刺引流术治疗,可缩短手术治疗时间,缩小脑水肿范围,降低血清Cor、ACTH水平和术后并发症发生率,有利于促进患者早日康复,值得在临床上推广应用。

Background Hypertensive cerebral hemorrhage develops rapidly.50%patients have severe headache,and about 10%patients have epileptic seizures,which will threaten the life safety of patients at any time after onset.Objective To investigate the effect of soft channel minimally invasive puncture and drainage on brain edema,serum cortisol(Cor)and adrenocorticotropic hormone(ACTH)levels in elderly patients with hypertensive intracerebral hemorrhage.Methods Sixtytwo elderly patients with hypertensive cerebral hemorrhage admitted to Wuxue No.1 People's Hospital from May 2018 to May 2020 were selected as research objects.According to the operation mode,the patients were divided into observation group(n=32)and control group(n=30).The control group was treated with traditional craniotomy,while the observation group was treated with soft channel minimally invasive puncture and drainage.General data,operation-related indexes(including operation time,hematoma clearance time,cerebrospinal fluid recovery time),peripheral brain edema volume at different time(preoperative,postoperative 1 week and postoperative 2 weeks),serum Cor and ACTH levels at different time(preoperative,postoperative 3 days and postoperative 7 days)and postoperative complications were compared between the two groups.Results The operation time,hematoma clearance time and cerebrospinal fluid recovery time in the observation group were shorter than those in the control group(P<0.05).There was an interaction between operation mode and time on the volume of peripheral brain edema(P<0.05).The main effect of operation mode and time on the volume of brain edema was significant(P<0.05).The volume of brain edema in the observation group was smaller than that in the control group at 1 week and 2 weeks after operation(P<0.05).The volume of brain edema in the control group and the observation group at 1 week and 2 weeks after operation was larger than that before operation,and the volume of brain edema at 2 weeks after operation was smaller than that at 1 week after operation,respectively(P<0.05).There is an interaction between operation mode and operation time on serum Cor and ACTH levels(P<0.05).The main effects of operation mode and time on serum Cor and ACTH levels were significant(P<0.05).The levels of Cor and ACTH in the observation group were lower than those in the control group at 3 days and 7 days after operation(P<0.05).The serum levels of Cor and ACTH in the control group and the observation group at 3 days after operation were higher than those before operation,and the serum levels of Cor and ACTH at 7 days after operation were lower than those before operation and at 3 days after operation(P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05).Conclusion Treating elderly patients with hypertensive intracerebral hemorrhage with soft channel minimally invasive puncture and drainage can shorten the operation time,reduce the scope of brain edema,reduce the levels of serum Cor and ACTH and the incidence of postoperative complications,which is conducive to the early recovery of patients,and is worthy of clinical application.